Organization
UAP LEBANON ENDO, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY M HARPER (OFFICER/AUTHORIZED OFFICIAL)
(972) 713-3547
Entity
Organization
Contact information
Practice address
100 PHYSICIANS WAY, STE 340, LEBANON, TN 37090-8102
(615) 466-9532
Mailing address
15305 DALLAS PKWY, #1600, ADDISON, TX 75001-4637
(972) 713-3547
(972) 534-1568
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6023768
BCBS OF TENNESSE, INC.
TN
05
—
Q008286
—
TN
Enumeration date
10/08/2012
Last updated
05/07/2015
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